献血员丙型肝炎病毒抗体酶免疫法检测试剂的测量值与其真阳性的相关性

目的研究丙型肝炎病毒抗体(抗HCV)酶免疫试验(EIA)检测试剂测量值／阳性判定值之比值(S／CO值)与真阳性的相关性，以确定预示≥95％真阳性的S／CO值。方法对采自北京、广州、杭州．昆明、乌鲁木齐等城市抗-HCV EIA初筛阳性的献血员标本159份，用强胜做拓临床诊断有限公司试剂(Ortho)及6种国产抗-HCV EIA试剂(北京华大吉比爱生物技术有限公司，简称华大吉比爱；北京金伟凯医学生物技术有限公司，简称金伟凯；河南华美生物工程有限公司，简称华美；上海实业科华生物技术有限公司，简称科华；厦门英科新创科技有限公司，简称英科新创；北京万泰生物药业有限公司，简称万泰)双孔复检，并用Chiron公司的Procleix HIV-1／HCV检测系统进行HCV RNA核酸扩增检测(NAT)，NAT阴性标本再用Chiron第三代重组免疫斑点试验(RIBA3．0)检测。HCV RNA或RIBA3．0阳性者判为真阳性，分析S／CO值与真阳性的相关性。结果7种抗HCV EIA试剂的S／CO值均与真阳性明显相关，Ortho S／CO≥3．8时，真阳性的预测值为96．1％，华大吉比爱S／CO≥7．0为96．1％，金伟凯S／CO≥10．0为96．1％，华美S／CO≥6．0为97．3％，科华S／CO≥10．0为96．0％，英科新创S／CO≥8．6为96．1％，万泰S／CO≥14．0为96．0％。结论抗HCV EIA试剂的S／CO值与真阳性明显相关，预示95％真阳性的S／CO值分别为Ortho≥3．8，华大吉比爱S／CO≥7．0，金伟凯S／CO≥10．0，华美S／CO≥6．0，科华S／CO≥10．0，英科新创S／CO≥8．6，万泰S／CO≥14．0。     

2种化学发光仪检测梅毒螺旋体特异性抗体性能分析

目的:以梅毒螺旋体免疫印迹法(TP-WB)为金标准,比较科美和雅培2种化学发光仪在检测梅毒特异性抗体时的差异。方法:选取科美检测梅毒阳性样本80例和雅培检测梅毒阳性样本80例,160例样本分别用2种化学发光检测梅毒特异性抗体后再用WB方法复检。结果:科美CLIA阳性预测值为90.07%,阴性预测值为88.89%,符合率为90.00%。雅培CMIA阳性预测值为93.19%,阴性预测值为100.00%,符合率为93.75%,两者差异无统计学意义(χ~2=0.950,P=0.330;χ~2=1.513,P=0.219;χ~2=1.507,P=0.220)。当科美S/CO9.01时阳性预测值为100%,雅培S/CO6.01时阳性预测值为100%,含有P47特征条带的样本数为108例(78.83%),为所有特征条带中出现频率最高。结论:科美和雅培化学发光在检测梅毒时与WB法比较均有较高符合率,雅培S/CO值≥6.01、科美S/CO值≥9.01时检测结果即为真阳性S/CO值,临床工作中可以使用价格较低廉的科美CLIA作为雅培CMIA的有效补充。     

2种化学发光仪检测梅毒螺旋体特异性抗体性能分析

目的:以梅毒螺旋体免疫印迹法(TP-WB)为金标准,比较科美和雅培2种化学发光仪在检测梅毒特异性抗体时的差异。方法:选取科美检测梅毒阳性样本80例和雅培检测梅毒阳性样本80例,160例样本分别用2种化学发光检测梅毒特异性抗体后再用WB方法复检。结果:科美CLIA阳性预测值为90.07%,阴性预测值为88.89%,符合率为90.00%。雅培CMIA阳性预测值为93.19%,阴性预测值为100.00%,符合率为93.75%,两者差异无统计学意义(χ~2=0.950,P=0.330;χ~2=1.513,P=0.219;χ~2=1.507,P=0.220)。当科美S/CO9.01时阳性预测值为100%,雅培S/CO6.01时阳性预测值为100%,含有P47特征条带的样本数为108例(78.83%),为所有特征条带中出现频率最高。结论:科美和雅培化学发光在检测梅毒时与WB法比较均有较高符合率,雅培S/CO值≥6.01、科美S/CO值≥9.01时检测结果即为真阳性S/CO值,临床工作中可以使用价格较低廉的科美CLIA作为雅培CMIA的有效补充。     

血清学联合核酸检测在献血者血液筛查中的互补性

目的对温州地区无偿献血者的血液标本进行血清学与核酸联合检测,全面评估血清学与核酸检测(NAT)在降低输血相关传染性疾病中的互补性。方法对2014年10月至2015年6月,温州市中心血站采集的无偿献血者的血液标本,用酶联免疫吸附试验(ELISA)对血液传染性指标乙型肝炎病毒表面抗原(HBsAg)、丙型肝炎病毒(HCV)抗体、艾滋病病毒(HIV)抗体、苍白球螺旋体(TP)抗体进行检测,丙氨酸转氨酶(ALT)采用速率法,同时采用核酸检测技术对乙型肝炎病毒(HBV)DNA、HCV RNA、HIV RNA进行6人份三项目联合检测,并对检测结果进行分析。结果 33 736份血液标本中,ELISA(+)NAT(+)95份,其中HBsAg(+)NAT(+)72份,符合率60.5%;HCV抗体(+)NAT(+)13份,符合率11.2%;HIV抗体(+)NAT(+)10份,符合率30.3%。41份ELISA(-)核酸(+)样本,且均为HBV DNA阳性。ELISA(+)NAT(-)173份。ELISA双试剂阳性样本中,HBV、HCV、HIV S/CO≥5的样本组的核酸阳性符合率高于S/CO5的样本组。结论核酸检测能有效地降低输血传播疾病的发生,但也存在漏检的可能,不能完全取代血清学检测,只有两者有机结合才能真正保证血液的安全。     

无偿献血者标本血清学和核酸检测情况分析

目的:分析无偿献血者标本血清学检测和核酸检测情况,为制定血液筛查策略提供依据,降低输血传播性病原体漏检率。方法:分别用2种ELISA试剂对无偿献血者标本进行HBsAg、抗-HCV、HIV抗原/抗体检测,用荧光定性PCR方法对HBsAg、抗-HCV、HIV抗原/抗体ELISA检测结果阴性、0.5≤S/CO≤5.0、S/CO5.0的标本进行HBV-DNA、HCV-RNA、HIV-RNA检测。对190份HBsAg(-)/HBV-DNA(+)献血者标本进行化学发光补充实验。结果:187 791例血清学检测阴性的无偿献血者标本中检出1例HIV-RNA病毒,194例HBV-DNA病毒,未检出HCV RNA病毒。科华和罗氏核酸检测系统拆分阳性率和阳性检出率差异无统计学意义(P0.05)。HBsAg、抗-HCV、HIV抗原/抗体ELISA双试剂阳性(S/CO10.0)标本HBV-DNA、HCV-RAN和HIV-RNA阳性检出率分别为88.89%、84.62%和100%,0.5≤S/CO≤10.0 ELISA双试剂阳性标本的HBV-DNA、HCV-RAN和HIV-RNA阳性检出率分别为69.44%(25/36)、0和0;HBsAg ELISA检测双试剂阳性结果不同组间(S/CO10.0和0.7≤S/CO≤10.0)核酸阳性检出率差异无统计学意义(P0.05)。对194例HBsAg(-)/HBV-DNA(+)中的190例标本进行化学发光补充实验,检出1例HBsAg阳性,HBcAb阳性检出率为90.00%。结论:HBsAg ELISA检测后HBV输血风险仍然较高(103/10万)。NAT技术的应用,降低了血液病毒窗口期、OBI等输血残余风险。HBsAg、抗-HCV、HIV抗原/抗体ELISA阳性反应的HBV-DNA、HCV-RAN、HIV-RNA检出率与ELISA检测S/CO值的高低及2种ELISA试剂检测结果一致程度有一定关联。采用灵敏度高的血清学方法和核酸检测技术,可进一步降低输血传播病原体的漏检率,保障输血安全。     

丙型肝炎核心抗原检测在丙型肝炎诊断中的意义

目的了解丙型肝炎核心抗原（HCV-cAg）检测方法的敏感性及特异性,确定具有临床意义的S/CO值,探讨其在丙型肝炎诊断中的意义。方法使用ELASA方法检测丙型肝炎核心抗原,RT-PCR检测HCV RNA定量,观察不同S/CO值所对应的HCV RNA定量之间的关系,以HCV RNA为诊断金标准,列四格表做诊断实验。结果 HCV-cAg抗原检测的敏感性为87.05%,特异性为76.67%,阳性预测值为96.53%,阴性预测值为44.23%。结论 （1）随着HCV-cAg的S/CO值逐渐增大,其与HCV RNA阳性符合率明显增高,随着HCV-cAg的S/CO值减小,其与HCV RNA阴性符合率明显增高;（2）S/CO值=2可以作为临床判断HCV感染病毒血症存在的一个标准;（3）本实验的敏感性和特异性较好,检测方法简单,可以作为丙型肝炎临床诊断的补充试验及筛查。     

HIV抗体检测替代策略在全人群中推广应用的可行性研究

目的评价艾滋病病毒(HIV)抗体检测替代策略在各类人群中检测HIV抗体的可靠性,探讨HIV抗体替代策略在全人群中推广的可行性。方法对1 040份筛查阳性的样本,用6种不同的快速试剂、1种酶联免疫吸附试验(ELISA)试剂及蛋白印迹法(WB)同时进行检测,对WB不确定样本做病毒载量(VL)检测,对检测结果进行比较。结果 1 040份筛查阳性样本中,WB检测结果为阳性的有1 007份,当2种快速试剂检测结果为阳性,ELISA试剂检测结果 S/CO≥1时,一致性为100%;WB检测结果为不确定,且VL检测结果为阳性的有20份,当2种快速试剂检测结果为阳性,ELISA试剂检测结果 S/CO≥6时,一致性为100%;以上结果在各类人群中均一致。结论当2种快速试剂检测结果为阳性,且ELISA试剂检测结果 S/CO≥6时,与WB或VL检测结果一致性达到100%,可以替代WB确证检测。在保证检测试剂质量的情况下,将HIV抗体检测替代策略向全人群推广应用是可行的。     

抗-HCVELISA间接法与双抗原夹心法试剂的应用对比评价

目的:对比研究国产抗-HCV ELISA间接法和双抗原夹心法试剂的检测效能,探讨血站抗-HCV检测模式。方法:选择1种双抗原夹心法酶联免疫试剂、2种间接法酶联免疫试剂分别检测34 593名无偿献血者血样,采用重组免疫印迹试验(RIBA)对其中有反应性的44份标本进行确认,并用BBI血清盘对这2种检测试剂进行考核评价。结果:科华、新创和万泰3个厂家的抗-HCV有反应性及灰区标本经RIBA实验确证后,假阳性率分别为31%、63%、13%。万泰双抗原夹心法与间接法相比,增加了反应强度、降低了假阳性率且缩短了窗口期。结论:为确保血液质量,血筛实验室应选择灵敏度和特异性双优的试剂,采用间接和双抗原夹心2种不同的ELISA试剂检测HCV抗体优于2种间接ELISA试剂,不仅提高抗-HCV有反应性标本的检出率,而且减少血液因假阳性造成的浪费。     

HIV抗体检测替代策略Ⅱ在云南省应用的可行性探讨

目的 评价用艾滋病病毒(HIV)抗体检测替代策略Ⅱ检测HIV抗体的可靠性,探讨HIV抗体检测替代策略Ⅱ在云南省应用的可行性.方法 对所有筛查阳性标本同时用替代策略Ⅱ及免疫印迹法(WB)检测,并对检测.结果 进行比较.结果 915份初筛阳性的标本中,两种酶联免疫吸附试验(ELISA)检测.结果 阳性且S/CO≥6的有854份,明胶颗粒凝集试验(PA)检测.结果 均为阳性,WB确认为阳性,符合率为100%;两种ELISA法检测.结果 均阳性,但其中1种或2种S/CO在1.0～5.9之间的共有61份,经WB确认检测,其中32份为阳性,28份为不确定,1份为阴性.结论 两种ELISA试剂和第三种高特异性筛查试剂联合检测HIV抗体,可以替代90%以上的WB确认检测.当两种ELISA法检测.结果 S/CO＞6,且第三种高特异性筛查试剂检测.结果 为阳性时,与WB确认检测.结果 符合率是100%;当1种或2种ELISA法检测.结果 1＜S/CO＜6时,三种方法与WB确认检测.结果 符合率仅为52.5%.因此,在使用HIV抗体替代策略Ⅱ时,应同时考虑ELISA法的反应强度(S/CO值)和其他筛查方法的.结果 .在综合考虑了以上因素后,HIV抗体检测替代策略Ⅱ在云南省应用是可行的.     

两种CLIA系统检测梅毒抗体的一致性及临界值设置

目的观察不同化学发光(CLIA)系统检测梅毒(TP)抗体与梅毒螺旋体明胶颗粒凝集试验(TPPA)的一致性并设定临界值。方法以博阳LICA500检测抗TP抗体S/CO1.0的血清样本296例﹑S/CO1.0的血清样本50例;同时以雅培i2000SR复检,以TPPA法进行确认检验。以TPPA为标准,方法间一致性比较采用Kappa检验;以TPPA为标准,绘制抗TP抗体S/CO比值受试者工作特征曲线(ROC曲线),得到约登指数最大时的S/CO比值以设定其临界值。结果雅培i2000SR抗TP抗体与TPPA检测结果的一致性较好(Kappa=0.826),博阳LICA500抗TP抗体与TPPA检测结果的一致性较差(Kappa=0.438);两者抗TP抗体与TPPA结果间的差异均具有显著性(P0.05)。雅培i2000SR检测抗TP抗体的灵敏度为100%,特异度为82.8%,阳性预测值为88.9%,阴性预测值为100%;而LICA500检测抗TP抗体的灵敏度为100%,特异度为61.9%,阳性预测值为73.0%,阴性预测值亦为100%。ROC曲线分析显示,博阳LICA500和雅培i2000SR检测抗TP抗体的曲线下面积分别为0.986和0.989;博阳LICA500抗TP抗体最佳诊断界值为10.095,其灵敏度为96.8%,特异度为97.5%;雅培i2000SR抗TP抗体最佳诊断界值为3.02,其灵敏度为95.8%,特异度为100%。结论不同化学发光系统检测梅毒抗体的诊断效能有差异,各实验室应设置最佳诊断界值并验证后使用。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.